American Collegiate Mens Ice Hockey Injuries
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American Collegiate Men’s Ice Hockey An Analysis of Injuries Kyle Flik, MD, Stephen Lyman, PhD, and Robert G. Marx,* MD, MSc, FRCSC From the Hospital for Special Surgery, New York, New York Background: Reported rates and types of ice hockey injuries have been variable. Ice hockey combines tremendous speeds with aggressive physical play and therefore has great inherent potential for injury. Purpose: To identify rates and determinants of injury in American men’s collegiate ice hockey. Study Design: Prospective cohort study. Methods: Data were collected from 8 teams in a Division I athletic conference for 1 season using an injury reporting form spe- cific for ice hockey. Results: There were a total of 113 injuries in 23 096 athlete exposures. Sixty-five percent of injuries occurred during games, although games accounted for only 23% of all exposures. The overall injury rate was 4.9 per 1000 athlete exposures (13.8 per 1000 game athlete exposures and 2.2 per 1000 practice athlete exposures). Collision with an opponent (32.8%) or the boards (18.6%) caused more than half of all injuries. Concussion (18.6%) was the most common injury, followed by knee medial col- lateral ligament sprains, acromioclavicular joint injuries, and ankle sprains. Conclusions: The risk of injury in men’s collegiate ice hockey is much greater during games than during practices. Concussions are a main cause for time lost and remain an area of major concern. Keywords: ice hockey; athlete exposures; injuries; concussions Considered one of the fastest and most aggressive team ations, eye injuries, and dental injuries are diminishing. sports, men’s ice hockey has great potential for injury. Nonetheless, blunt trauma remains the most common Players move on sharp skates at speeds of up to 30 mph on cause of injury, followed by fatigue and overuse.4,17 a solid ice surface that is confined by rigid boards along The rate and types of ice hockey injuries at different lev- the rink’s periphery. Sticks made of wood, carbon graphite, els of play vary throughout the world.1-4,7,8,10-12,14,17,19 When or aluminum are used to propel a piece of vulcanized rub- comparing injury data from American elite hockey players ber at speeds of up to 100 mph (161 km/h).15 The goalposts, with that from their European counterparts, one must which are made of steel, add an additional hazard. In such understand the subtle differences in the North American a setting, injuries are to be expected. and European games. In general, the North American Ice hockey is played in many countries throughout the style of play is considered more aggressive and physical world and has become a popular sport for both men and than that in Europe, where many prior studies were per- women in many regions of the United States. At the elite formed. In addition, the surface area of American rinks level, this unique team sport is played by highly condi- (approximately 1560 m2) is considerably smaller than tioned athletes and requires a combination of strength, European rinks (1800 m2). For these reasons, it may be agility, balance, skill, and controlled aggression. reasonable to expect injury patterns to be different between Specialized equipment is needed to protect players from American and European amateur elite hockey leagues. each other, the ice, boards, goalposts, skates, pucks, and The objective in this study was to describe the injury sticks. With improved protection and required use of hel- patterns in collegiate men’s ice hockey in the United mets with facemasks, certain injuries such as facial lacer- States with respect to the distribution of injuries by body region, player position, type of exposure (game vs prac- *Address correspondence to Robert G. Marx, MD, MSc, FRCSC, tice), timing of injuries, and the associated time lost from Sports Medicine and Shoulder Service, Director, Foster Center for participation. Clinical Outcome Research, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 (e-mail: [email protected]). No potential conflict of interest declared. MATERIALS AND METHODS The American Journal of Sports Medicine, Vol. 33, No. 2 DOI: 10.1177/0363546504267349 All data were collected prospectively during the 2001-2002 © 2005 American Orthopaedic Society for Sports Medicine season. The athletic trainers of all 12 Eastern College 183 184 Flik et al The American Journal of Sports Medicine Athletic Association Division I Men’s Ice Hockey programs analysis was performed using SPSS for Windows version were contacted and asked to participate. Eight schools 11.0 (SPSS Science Inc, Chicago, Ill). agreed and were included. An anonymous ice hockey injury data capture form was developed to record detailed information regarding each injury (Appendix, available in RESULTS the online version of the article at www.ajsm.org/cgi/content/ There were a total of 113 injuries in 23 096 AEs for a total 33/2/183/dc1). Injury data were recorded by using this overall injury rate of 4.9 per 1000 AEs (Table 1). The game method for each qualifying injury. A pilot study was per- injury rate was 13.8 per 1000 AEs (74 injuries in 259 formed 2 years before this to evaluate the form and con- games), whereas the practice rate was 2.2 per 1000 AEs firm its ease of use. (39 injuries in 676 practices) for a risk ratio of 6.3. The certified athletic trainer on each team was respon- Therefore, game injuries were 6.3 times more common sible for entering injury data at the completion of each than practice injuries (P < .001). Forwards and defense- exposure. The injury form was mailed to the study center men had similar injury rates, whereas goalies had signifi- at the end of each month, providing the opportunity to cantly lower injury rates during games (P < .05) (Figure 1). change the initial diagnosis if further testing or review of The incidence of game injuries was slightly higher in the the injury by a team physician led to a change in diagno- first half of the season (57%) than in the second half (43%). sis. For each injury, the player’s age, height, weight, and Of the 74 game injuries, 27 occurred in the first period, 27 position were recorded. Included in the information gath- in the second period, and 20 in the third period. Fifty seven ered was whether the injury occurred during practice or a percent of injuries occurred to a player who was on the vis- game, the period within the game, and the location on the iting team, and 43% occurred to a home player. ice. In addition, it was noted if the injured body part was A collision, either with an opponent (32.8%) or the protected by equipment or had been previously injured. boards (18.6%), was the cause for more than half of all The injured player and the team’s trainer determined the injuries (Figure 2). Skates, sticks, or pucks were directly direct cause of the injury. Time lost was calculated by responsible for only 11.5% of all injuries. Eight percent of adding all consecutive practices and games that were injuries were considered overuse injuries. For only 9 missed because of the injury. Additional documentation injuries did the team trainer feel that the injury was pre- included whether the injury was due to illegal activity and ventable by better equipment, conditioning, or refereeing. whether this activity was penalized. Information was also Injuries during games were related to collisions in 69%, collected on the diagnostic procedures required, the treat- whereas practice injuries were related to collisions in only ment received, and the final diagnosis. Ultimately, the 38%. Nearly 40% of all injuries occurred along the boards. trainers were asked the question, “Do you believe the Concussion was the single most commonly sustained injury could have been prevented by better equipment, injury (18.6% overall) and was responsible for nearly one conditioning, or refereeing?” quarter of all game injuries. Of the 21 concussions recorded, An athlete exposure (AE) consisted of a single player only 4 (19%) occurred during practice. Six of the 17 game participating in a single game or practice. Exposure infor- concussions were thought to be due to illegal activity, with mation was recorded based on the at-risk population no penalty called on the play. Elbowing was the most com- determined by the average number of players at each posi- mon illegal play. It was felt that the injury could not have tion participating at practices and the number participat- been prevented in 8 cases and could have been prevented ing in each game. A specific daily attendance log was not by better equipment in 3 cases. The average time loss for kept. An injury was defined specifically as any injurious each concussion was 2.1 games and 6.9 practices (approxi- episode that led to loss of participation in the immediate mately 9 AEs total). Of the 21 concussions, forwards sus- subsequent AE, whether it was a practice or a game. The tained 16 and defensemen suffered 5. injury definition was validated on the injury form by Knee medial collateral ligament (MCL) sprains were the recording specific time loss information. second most frequent injury. Interestingly, these were all Each team’s athletic trainer was responsible for com- game related; no MCL sprains occurred during practices. pleting the injury forms and returning them to the study The injury type that led to the longest average time lost center at the end of the season. Each trainer was contacted was a syndesmotic ankle sprain (“high ankle sprain”). Five bimonthly to ensure compliance. For each team, exposure such injuries resulted in a mean of 5.4 games and 14.6 information was calculated based on number of games and practices missed.